6,900 low-income Oklahomans to be cut from Insure Oklahoma

Melody Cauthon's children -- MaKenna (left), Waylon and Ameris play at Black Gold Park in Glenpool. Her children qualify for SoonerCare but Melody (not pictured) is one of 6,900 people who are going to lose their Insure Oklahoma insurance on Jan. 1.  CORY YOUNG/Tulsa World

When Melody Cauthon spent six days in the hospital with Rocky Mountain spotted fever last year, the hospital bill totaled $28,000.

Thanks to her coverage through Insure Oklahoma, Cauthon paid only $50.

Cauthon, a single mother of three children, said the insurance program operated by the state of Oklahoma is the best health-insurance plan she has ever had. But on Jan. 1, Cauthon and 6,900 other Oklahomans will no longer be covered by the popular state-run program.

Cauthon received the news two weeks ago in a letter telling her that income guidelines for the program had changed and she no longer qualified. As part of a deal between the state and federal governments to extend Insure Oklahoma for one year, state officials agreed to reduce income eligibility from 200 percent of the federal poverty level to 100 percent.

"I am just frustrated because I had affordable health-care coverage through Insure Oklahoma," said Cauthon, 39.

"Because the federal government and the state of Oklahoma cannot come to a general consensus, I now lose my affordable insurance company. I now have to find a second job to pay for my insurance premiums."

Gov. Mary Fallin lobbied for the extension after federal officials said the program must end because it did not comply with the Affordable Care Act.

Insure Oklahoma is funded by a mix of state and federal funds and premiums that people pay based on their income. However, the program capacity is capped at 35,000 people.

About 30,000 people are now covered by Insure Oklahoma's individual and employer-based programs.

The rule change means people in the program who make more than about $11,500 per year for an individual or $23,500 for a family of four no longer qualify. The rule change applies only to people who receive individual coverage through Insure Oklahoma and does not affect those covered through their employers.

As part of the agreement to extend Insure Oklahoma, federal officials required reduced income eligibility to shift those people over to plans offered through the Affordable Care Act. People who make from 100 percent to 400 percent of the federal poverty level can qualify for subsidies that reduce the cost of plans purchased through the insurance exchange.

That may make sense to federal bureaucrats but the change has left Cauthon angry and worried.

Cauthon said Insure Oklahoma "is the best insurance that I have seen and I did medical billing for 17 years."

Jennie Melendez, a spokeswoman for the Oklahoma Health Care Authority, said the agency notified people who would lose coverage as soon as possible so they could review their options. Enrollment in plans under the Affordable Care Act began Oct. 1 and ends March 31.

"We are just trying to focus on the people we were able to keep ... and we wanted to make sure we were prudent with getting out notification so that they could go to the marketplace or even SoonerCare," Melendez said.

Matt Lucas, director of the Insure Oklahoma program, said the Health Care Authority has received calls from people who are upset about losing coverage.

"People did like the program, do like the program, and they wish they could continue on in the program."

Lucas said for people such as Cauthon, "If she gets approved on the exchange, I would anticipate the coverage to be as good or better than what she can get on the individual (Insure Oklahoma) plan."

The federal agency that operates the exchange has struggled with technical glitches and system overload since enrollment began Oct. 1. While insurers report that some Oklahomans have actually enrolled in coverage, the federal government so far has refused to release enrollment statistics.

Cauthon said after initial technical problems prevented her from getting onto the exchange, she was able to get information Saturday. She said rates available through the exchange are about twice what she pays now.

"I don't mind paying more if the coverage were the same but it's not going to be," she said.

Cauthon said she paid $73 per month for Insure Oklahoma and will have to take a second job in addition to her current job at a collections company.

"I am frustrated. I am not a big fan of 'Obamacare' and Insure Oklahoma was established long before Obama was even a household name."

Rates paid for plans offered through the exchange vary based on age, income, area of the state and smoking status. Plans range from a bronze plan that covers about 60 percent of health-care costs to a platinum plan that covers 90 percent of health-care costs.

Cauthon said her children — ages 15, 12 and 5 — qualify for SoonerCare, the state Medicaid program.

When she found out she would no longer qualify for Insure Oklahoma, Cauthon didn't just get angry, she got on the phone. She called the offices of her elected representatives from the governor all the way to the president.

"When I first found out about this ... I called Fallin's office. I called Coburn's office, I even called the White House. Of course it's the blame game. The White House says, 'It's your governor and state legislators who don't want to expand Medicaid eligibility.' ''

Fallin's office told Cauthon federal officials "are wanting to bankrupt the state of Oklahoma" by pushing the state to accept an expanded Medicaid program.

Last year, Fallin rejected Affordable Care Act funding for a Medicaid expansion in Oklahoma, arguing that the state's potential share of the expansion was too great. The state is among 26 states that rejected the expanded Medicaid funding.

Under the Affordable Care Act, the federal government will pick up 100 percent of the costs of newly eligible Medicaid clients for the first three years. After three years, an increasing share would be shifted to the state, capping at 10 percent in 2020.

Critics of the Affordable Care Act, including the Oklahoma Council on Public Affairs, have said the federal government vastly underestimates the cost of such programs and the state would end up paying far more for expanding Medicaid.

SoonerCare, the state's Medicaid program, currently provides health coverage for low-income children, pregnant women, the blind and disabled, and people over age 64.

Adults between 19 and 64 without children do not qualify for SoonerCare unless they are blind or disabled. Individuals with children can earn no more than about $300 a month to receive the coverage.

About 150,000 Oklahomans will fall into a coverage gap because they make too much for SoonerCare but not enough to qualify for subsidized coverage under the Affordable Care Act. The federal government didn't count on states rejecting expanded Medicaid funding so the law's subsidies do not cover people making incomes below the federal poverty level.

Emma Sandoe, a spokeswoman for the Centers for Medicare and Medicaid Services, said in an email: "We look forward to working with Oklahoma and all other states in bringing a flexible, state-based approach to Medicaid coverage expansion and encourage the state to explore these options."

CMS is the agency responsible for implementing the Affordable Care Act.

"We encourage all states to adopt the Medicaid funding made possible by the Affordable Care Act, which provides 100 percent federal funding for three years and never falls below 90 percent federal funding for people newly eligible for Medicaid," Sandoe's email states.

Cauthon said people should let their elected representatives know their opinions about changes in health-care programs such as Insure Oklahoma. She said she believes people should maintain health insurance so others aren't burdened by having to pay for their care through higher insurance rates.

"I am not trying to say who is to blame. I am saying there was a system in place that was working for individuals such as myself."

Ziva Branstetter 918-581-8306

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